DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Impending renal failure.
POSTOPERATIVE DIAGNOSIS:
Impending renal failure.
TITLE OF OPERATION:
Left forearm Cimino arteriovenous fistula.
SURGEON: John Doe, MD
ANESTHETIC: MAC, local.
ESTIMATED BLOOD LOSS: Minimal.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was brought to the operating room and placed on the operating room table in the supine position. After induction of MAC anesthetic, the left arm was prepped and draped in the usual sterile fashion. A longitudinal area of skin was anesthetized with local anesthetic between the level of the left radial artery and the cephalic vein. An approximately 3 to 4 cm incision was then made with #15 blade scalpel. Sharp dissection was used to isolate a suitable vein, which was freed up, small branches being clipped for a distance of approximately 5 to 6 cm up the arm. Once this was complete, the distal aspect of the vein was triple-clipped and then cut at that point. Attention was then turned to the radial artery, which was isolated, with care taken to not injure the intervening sensory nerve located between the vein and the artery. Radial artery had a good pulse, was soft and was mobilized for a segment of approximately 2 to 3 cm. Bulldog clamps were then placed for proximal and distal control and a small arteriotomy was made with a #11 blade scalpel. This was then lengthened to approximately 4 mm using a Potts scissors and the cut end of vein was then appropriately cut to length and spatulated. The anastomosis was then performed with interrupted #20 U clips. Approximately 12 U clips were used to perform the anastomosis in interrupted fashion. At the conclusion of the anastomosis, the bulldog clamps were released and there was good arterial flow noted through the radial artery into the hand, as well as pulsatile flow through the cephalic vein back up into the arm. In addition, a U clip was placed for hemostasis, and Doppler evaluation as well as palpation confirmed good flow to the radial artery to the hand, as well as good flow through the fistula. There was a strong ulnar pulse as well. Wound was then irrigated, suctioned dry, inspected for adequate hemostasis and the skin was closed in subcuticular fashion with 4-0 Vicryl suture. The patient tolerated the procedure well and was brought to the recovery room without incident.
